Analyst, Case Management - Field - Must reside in Winnebago County Illinois

CVS Health • Rockford, IL

30d • $21 - $45 • Onsite

About The Position

At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues - caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.Position SummaryThis Analyst, Case Management Field position is with Aetna's Long-Term Services & Supports (LTSS) team and is a field-based position out of the Winnebago County/Rockford area in Illinois. The requirements is for candidates to travel 50-75% of the time to meet with members face to face. This position holds a full caseload to manage waiver members. This position requires in person quarterly visits with members. This position is critical to meet contractual requirements. Facilitate appropriate healthcare outcomes for waiver/LTSS members by providing care coordination, support and education for members through the use of care management tools and resources.Evaluation of Members:Through the use of care management tools and information/data review, conducts comprehensive evaluation of referred members' needs/eligibility and recommends an approach to case resolution and/or meeting needs by evaluating members' benefit plan and available internal aid and external programs/services.Identifies high risk factors and service needs that may impact member outcomes and care planning components with appropriate referral to clinical case management or crisis intervention as appropriate.Coordinates and implements assigned care plan activities and monitors care plan progress.Enhancement of Medical Appropriateness and Quality of Care:Using holistic approach consults with case managers, supervisors, Medical Directors and/or other health programs to overcome barriers to meeting goals and objectives; presents cases at case conferences to obtain multidisciplinary review in order to achieve optimal outcomes.Identifies and escalates quality of care issues through established channels.Utilizes negotiation skills to secure appropriate options and services necessary to meet the member's benefits and/or healthcare needs.Utilizes influencing/motivational interviewing skills to ensure maximum member engagement and promote lifestyle/behavior changes to achieve optimum level of health.Provides coaching, information and support to empower the member to make ongoing independent medical and/or healthy lifestyle choices.Helps member actively and knowledgeably participate with their provider in healthcare decision-making.Monitoring, Evaluation and Documentation of Care:Utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.

Requirements

• Must reside in the state of Illinois in Winnebago County IL or Surrounding Areas
• Case management experience
• Microsoft Office and electronic health record experience
• Valid Illinois Driver's license
• Willing and able to travel up to 75% of their time to meet with members face to face.
• Reliable Transportation required, eligible for mileage reimbursement as per company policy
• Bachelor's degree or a non-licensed individual with a master's degree, with either degree being in a human-services field (including, but not limited to sociology, special education, rehabilitation counseling)

Nice To Haves

• Case management and discharge planning experience preferred (2 years)
• Managed Care experience preferred
• Microsoft Office experience preferred

Responsibilities

• Facilitate appropriate healthcare outcomes for waiver/LTSS members by providing care coordination, support and education for members through the use of care management tools and resources.
• Through the use of care management tools and information/data review, conducts comprehensive evaluation of referred members' needs/eligibility and recommends an approach to case resolution and/or meeting needs by evaluating members' benefit plan and available internal aid and external programs/services.
• Identifies high risk factors and service needs that may impact member outcomes and care planning components with appropriate referral to clinical case management or crisis intervention as appropriate.
• Coordinates and implements assigned care plan activities and monitors care plan progress.
• Using holistic approach consults with case managers, supervisors, Medical Directors and/or other health programs to overcome barriers to meeting goals and objectives; presents cases at case conferences to obtain multidisciplinary review in order to achieve optimal outcomes.
• Identifies and escalates quality of care issues through established channels.
• Utilizes negotiation skills to secure appropriate options and services necessary to meet the member's benefits and/or healthcare needs.
• Utilizes influencing/motivational interviewing skills to ensure maximum member engagement and promote lifestyle/behavior changes to achieve optimum level of health.
• Provides coaching, information and support to empower the member to make ongoing independent medical and/or healthy lifestyle choices.
• Helps member actively and knowledgeably participate with their provider in healthcare decision-making.
• Utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.

Benefits

• Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
• No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
• Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Industry: Ambulatory Health Care Services
• Number of Employees: 5,001-10,000 employees